Initial experience of surgical microwave f issue precoagulation in liver resection for hepatocellular carcinoma in cirrhotic liver

Surgical hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for HCC, however, HCC is usually associated with poor liver function owing to chronic hepatitis or liver cirrhosis. Techniques that can eradicate the tumor and also preserve liver function are needed. Moreover, hepatic resection, in the presence of cirrhosis, raises special problem of high risk as hemorrhage and liver failure, thus, good clinical results can only be achieved by minimizing operative blood loss, time of the intervention as well as the hepatic reserve. The tremendous progress in microwave technology has recently attracted considerable attention. This study evaluated the feasibility of this new liver transection technique demonstrating the high performance of this procedure, the accuracy in terms of squeeze effect on veins and portal branch and in terms of reducing the intra operative blood loss, and minimizing the operative time for safe hepatectomy.Twenty-six consecutive patients a first-time diagnosis of hepatocellular carcinoma [HCC] on top of liver cirrhosis were recruited for the study, from August 2011 to January 2013.A11 patients were subjected to full clinical examination, laboratory investigations, abdomen ultrasound [U/S], triphasic computed tomographic liver scan [CT] and dynamic magnetic resonance imaging [MRI] in some doubtful cases. Inclusion requirements were presence of resec-table disease without vascular invasion or extrahepatic spread at imaging, Child-Pugh class A and B [Score 7] liver cirrhosis, [INR]< 1.6or platelet count >60 000/mm3 with no previous treatment. Patients were treated by applying pre-coagulation of the liver transection lines using microwave probe positioned in parallel to the line of resection by open approach after intra-operative U/S assessment for localization of the tumor and line of resection.The procedures were performed under general anesthesia. Mobilization of the liver was not necessary to be done in all cases. Intra-operative ultrasound [Aloka, Tokyo, Japan] was used to exclude lesions not detected pre-operatively [operative surprise], to define the location, number and size of the tumor and to identify large intra-hepatic large vascular and biliary structures, and guide insertion of the microwave applicator. Intraoperative ultrasound was used again, to assess that the line of resection was done. Primary endpoints documented were total operative time, time for liver parenchyma transection, intraoperative blood loss and blood transfusion requirements. Secondary endpoints included postoperative complications, mortality and intensive care unit [ICU] together with hospital stay

Gastrointestinal stromal tumors [GISTS]: clinical presentation, diagnosis, surgical treatment and its outcome

This study included 13 selected patients treated by surgical excision for lesions that proved postoperatively to be gastrointestinal stromal tumors [GISTs] by histopathological and immunohistochemistry studies. The demographic, clinical and operative reports data were collected. Eight cases were gastric GISTs, four cases were small bowel GISTs [jejunum 1 and ileum, 3] and GIST of the sigmoid colon was in one patient. Eight cases presented at the emergency department due to hematemesis [3], gastrointestinal obstruction [3], bowel perforation [1] and severe bleeding per rectum [1]. Three cases presented with a feeling of abdominal fullness and ill-defined palpable abdominal mass. Two cases were discovered incidentally during GIT endoscopy for dyspepsia. Diagnosis of GISTs was presumed on clinical basis and operative findings from gross morphological features. Complete resection [RO] was achieved for 12 tumors [92.3%]. The immunohistochemistry profile was positive for C-kit for all cases. One operative death was due to massive pulmonary embolism. Postoperative complications occurred in three [23%] as upper GIT bleeding [1], biliary gastritis [1] and wound infection [1], and one [7.69%] of ileum tumor recurrence